CALIFORNIA

A S S O CIATION
OF REALTORS

APPLICATION TO RENT/SCREENING FEE

(C.A.R. Form LRA, Revised 11/09)

I. APPLICATION TO RENT

THIS SECTION TO BE COMPLETED BY APPLICANT. A SEPARATE APPLICATION TO RENT IS REQUIRED FOR EACH
OCCUPANT 18 YEARS OF AGE OR OVER, OR AN EMANCIPATED MINOR.
Applicant is completing Application as a (check one) n tenant, n tenant with co-tenant(s) or n guarantor/co-signor.
Total number of applicants ____________________________________________________________________________________.

PREMISES INFORMATION

Application to rent property at _______________________________________________________________________ (Premises)

Rent: $____________________ per _________ Proposed move-in date ______________________________________________

PERSONAL INFORMATION

T
AF
DR

FULL NAME OF APPLICANT _________________________________________________________________________________

Social security No. _________________________ Drivers license No. __________________ State _____ Expires ______________
Phone number: Home ________________________ Work __________________________ Other ___________________________
Email _____________________________________________________________________________________________________
Name(s) of all other proposed occupant(s) and relationship to applicant _________________________________________________
__________________________________________________________________________________________________________
Pet(s) or service animals (number and type) ______________________________________________________________________
Auto: Make _________________ Model _____________ Year _______ License No. ____________ State ______ Color ___________
Other vehicle(s): ____________________________________________________________________________________________

In case of emergency, person to notify ________________________________________________ Relationship _________________

Address _____________________________________________________________________ Phone ________________________

Does applicant or any proposed occupant plan to use liquid-filled furniture? n No n Yes Type _________________________________

Has applicant been a party to an unlawful detainer action or filed bankruptcy within the last seven years?

n No

n Yes

If yes, explain _______________________________________________________________________________________________

Has applicant or any proposed occupant ever been convicted of or pleaded no contest to a felony?

n No

n Yes

If yes, explain _______________________________________________________________________________________________

Has applicant or any proposed occupant ever been asked to move out of a residence?

n No

n Yes

If yes, explain _______________________________________________________________________________________________

RESIDENCE HISTORY

Current address _______________________________________ Previous address _______________________________________

City/State/Zip ________________________________________ City/State/Zip __________________________________________
From _____________________ to _______________________ From _____________________ to _________________________
Name of Landlord/Manager ______________________________ Name of Landlord/Manager ______________________________
Landlord/Managers phone ______________________________ Landlord/Managers phone _______________________________
Do you own this property? n No n Yes
Did you own this property? n No n Yes
Reason for leaving current address _______________________ Reason for leaving this address ___________________________
____________________________________________________ _____________________________________________________
____________________________________________________ _____________________________________________________

EMPLOYMENT AND INCOME HISTORY

Current employer ______________________________________

Employers address ____________________________________
Position or title ________________________________________
Employment gross income $ __________________ per ________
Previous employer _____________________________________
Employers address ____________________________________
Position or title ________________________________________

The copyright laws of the United States (Title 17 U.S. Code) forbid the unauthorized
reproduction of this form, or any portion thereof, by photocopy machine or any other
means, including facsimile or computerized formats. Copyright 1991-2009,
CALIFORNIA ASSOCIATION OF REALTORS, INC. ALL RIGHTS RESERVED.

LRA REVISED 11/09 (PAGE 1 OF 2)

Supervisor ____________________ From _______ To ________

Supervisors phone ______________________________________
Phone number to verify employment ________________________
Other $ ________ per _________ Source ____________________
Supervisor ___________________ From _______ To ________
Supervisors phone ______________________________________
Employment gross income $ _____________________ per _______
Applicants Initials (__________)(__________)
Reviewed by _______ Date _______

APPLICATION TO RENT/SCREENING FEE (LRA PAGE 1 OF 2)

Property Address: ________________________________________________________

Name of creditor

Name of bank/branch

CREDIT INFORMATION

Date: __________________

Account number

Monthly payment

Balance due

Account number

Type of account

Account balance

PERSONAL REFERENCES

T
AF
DR

Name __________________________________ Address ___________________________________________________________

Phone ____________________ Length of acquaintance __________ Occupation _________________________________________

Name __________________________________ Address ___________________________________________________________

Phone ___________________ Length of acquaintance __________ Occupation _________________________________________

NEAREST RELATIVE(S)

Name __________________________________ Address ___________________________________________________________

Phone _________________________________ Relationship ________________________________________________________

Name __________________________________ Address ___________________________________________________________

Phone _________________________________ Relationship ________________________________________________________

Applicant understands and agrees: (i) this is an application to rent only and does not guarantee that applicant will be offered the
Premises; and (ii) Landlord or Manager or Agent may accept more than one application for the Premises and, using their sole discretion,
will select the best qualified applicant.
Applicant represents the above information to be true and complete, and hereby authorizes Landlord or Manager or Agent to: (i) verify
the information provided; and (ii) obtain credit report on applicant.
If application is not fully completed, or received without the screening fee: (i) the application will not be processed, and (ii)
the application and any screening fee will be returned.

Applicant _________________________________________________________ Date ________________________ Time _________

Return your completed application and any applicable fee not already paid to: _________________________________________
Address ________________________________________________ City _________________________ State ______ Zip ________

II. SCREENING FEE

THIS SECTION TO BE COMPLETED BY LANDLORD, MANAGER OR AGENT.

Applicant has paid a nonrefundable screening fee of $ _____________________________, applied as follows: (The screening fee may
not exceed $30.00, adjusted annually from 1-1-98 commensurate with the increase in the Consumer Price Index. A CPI inflation
calculator is available on the Bureau of Labor Statistics website, www.bls.org. The California Department of Consumer Affairs calculates
the applicable screening fee amount to be $37.57 as of 2006.
$ __________________________ for credit reports prepared by _______________________________________________________;
$ __________________________ for ________________________________________________ (other out-of-pocket expenses); and
$ __________________________ for processing.
The undersigned has read the foregoing and acknowledges receipt of a copy.
_________________________________________________________________________________ ________________________
Applicant Signature

Date

The undersigned has received the screening fee indicated above.

__________________________________________________________ DRE Lic. # _____________________
Landlord or Manager or Agent Signature

________________
Date

THIS FORM HAS BEEN APPROVED BY THE CALIFORNIA ASSOCIATION OF REALTORS (C.A.R.). NO REPRESENTATION IS MADE AS TO THE LEGAL VALIDITY OR
ADEQUACY OF ANY PROVISION IN ANY SPECIFIC TRANSACTION. A REAL ESTATE BROKER IS THE PERSON QUALIFIED TO ADVISE ON REAL ESTATE
TRANSACTIONS. IF YOU DESIRE LEGAL OR TAX ADVICE, CONSULT AN APPROPRIATE PROFESSIONAL.
This form is available for use by the entire real estate industry. It is not intended to identify the user as a REALTOR. REALTOR is a registered collective membership mark
which may be used only by members of the NATIONAL ASSOCIATION OF REALTORS who subscribe to its Code of Ethics.
Published and Distributed by:
REAL ESTATE BUSINESS SERVICES, INC.
a subsidiary of the California Association of REALTORS
525 South Virgil Avenue, Los Angeles, California 90020

LRA REVISED 11/09 (PAGE 2 OF 2)

Reviewed by _______ Date _______

APPLICATION TO RENT/SCREENING FEE (LRA PAGE 2 OF 2)